Ulrike Boehmer

Twenty Years of Public Health Research: Inclusion of Lesbian, Gay, Bisexual, and Transgender Populations

OBJECTIVES This study determined to what extent lesbian, gay, bisexual, and transgender (LGBT) populations have been studied over the past 20 years of public health research. METHODS From MEDLINE English-language articles on human subjects published between 1980 and 1999, I identified articles that included LGBT individuals. The abstracts were analyzed with a coding procedure that categorized the content by topic, sexual orientation, and race/ethnicity. RESULTS LGBT issues were addressed by 3777 articles, or 0.1% of all Medline articles; 61% of the articles were disease-specific, and 85% omitted reference to race/ethnicity. Research unrelated to sexually transmitted diseases addressed lesbians and gay men with similar frequency, whereas bisexual persons were less frequently considered, and the least amount of research focused on transgender individuals. CONCLUSIONS Findings supported that LGBT issues have been neglected by public health research and that research unrelated to sexually transmitted diseases is lacking.

Self-Reported vs Administrative Race/Ethnicity Data and Study Results

Concerns about administrative data on race/ethnicity have led some researchers to consider self-reported race/ethnicity as superior.1–5 However, few studies have examined the differential impact of the source of race/ethnicity data, that is, observed or selfreported, on study outcomes. We investigated whether differences in reporting of race/ethnicity led to different results with regard to the use of one therapeutic dental procedure, root canal therapy.

Physicians Don't Ask, Sometimes Patients Tell Disclosure of Sexual Orientation among Women with Breast Carcinoma

The disclosure of sexual orientation to physicians is uncertain and the reasons are poorly understood. The current study was undertaken to describe the disclosure of sexual orientation among sexual minority women with breast carcinoma.

Adult Health Behaviors Over the Life Course by Sexual Orientation

OBJECTIVES We estimated differences in health behaviors among adults by sexual orientation. METHODS We pooled 4 years of data (2001, 2003, 2005, and 2007) from the California Health Interview Survey. We estimated the frequency of smoking, alcohol use, healthy dietary behaviors, physical activity, and health care utilization, and we used logistic regression modeling to determine the odds of each behavior with increasing age and for 2 age groups: younger than 50 years and 50 years old or older. RESULTS At any adult age, lesbians had greater odds of smoking and binge drinking than did heterosexual women, and gay and bisexual men had greater health care utilization than did heterosexual men. Other risk behaviors differed with age. CONCLUSIONS Some behavioral change interventions should target lesbians, gays, and bisexuals at all ages, whereas other interventions should specifically target individuals at younger ages.

Examining factors linked to overweight and obesity in women of different sexual orientations

OBJECTIVES Our goal was to examine possible mechanisms for the relationship of sexual minority status and obesity. The mechanisms we considered were energy intake, measured as consumption of fruits and vegetable, past diet attempts and energy expenditure measured as physical activity and number of days when poor physical or mental health interfered with usual activities. We hypothesized that women with a female partner have greater energy imbalance by expending less energy and have higher energy intake than women with a male partner thereby causing overweight and obesity. METHODS The study was a secondary data analysis of the California Womens Health Survey (CWHS), an annual probability survey that produces a representative sample of the female California population. After pooling data from the years 2001-2005, we obtained a representative sample of 14,197 Californian women. Multiple regression analyses were used to test for mediation. RESULTS We found higher prevalence of overweight and obesity in sexual minority women. There was no support for mediation in that gender of sexual partner was not significantly related to measures of energy intake and expenditure. CONCLUSIONS The findings from the present study further implicate sexual minority status in the risk for overweight and obesity, yet do not identify the chosen measures of energy intake and expenditure as mediators for this relationship.

Increased Preventive Practices Lead to Greater Tooth Retention

Prior research has rarely examined the impact of ADA-recommended preventive practices on tooth retention. We hypothesized that better oral hygiene leads to increased tooth retention. We examined the association of cross-sectional and long-term assessments of preventive practices, as well as various combinations of hygiene practices, with tooth retention. Among 736 male participants in the VA Dental Longitudinal Study, we utilized cross-sectional and longitudinal self-reports of toothbrushing, dental floss use, annual prophylaxis, and combinations of such behaviors, and examined their association with clinically assessed numbers of teeth. Baseline and long-term hygiene behaviors (except brushing) were associated with an increased baseline number of teeth and decreased subsequent tooth loss. Use of multiple hygiene behaviors was associated with greater tooth retention, cross-sectionally and longitudinally. Adherence to ADA recommendations for preventive care leads to better oral health, and consistently practicing preventive behaviors over the long term confers greater benefits than doing so over the short term.

Parents’ Supportive Reactions to Sexual Orientation Disclosure Associated With Better Health: Results From a Population-Based Survey of LGB Adults in Massachusetts

This study investigated associations between coming out to parents, experiences of parental support, and self-reported health behaviors and conditions among a population-based sample of LGB individuals using data collected via the 2002 Massachusetts Behavioral Risk Factor Surveillance System (BRFSS; N = 177). We explored the following two hypotheses: 1) Lesbian, gay, and bisexual (LGB) individuals who had never disclosed their sexual orientation to a parent would report higher levels of risk behaviors and poorer health conditions than those who had come out; and 2) among LGB respondents who had come out to their parents, the individuals whose parents had reacted unsupportively would report higher levels of risk behaviors and poorer health conditions than those who had come out to parents who were supportive. Approximately two thirds of gay and bisexual (GB) males and lesbian and bisexual (LB) females reported receiving adequate social and emotional support from the parent to whom they first disclosed their sexual orientation. Among LB females, no disclosure of sexual orientation to a parent was associated with significantly elevated levels of past-month illicit drug use (AOR 12.16, 95% CI 2.87–51.54), fair or poor self-reported health status (AOR 5.71, 95% CI 1.45–22.51), and >15 days of depression in the past month (AOR 5.95, 95% CI 1.78–19.90), controlling for potential confounders. However, nondisclosure to a parent by GB males was not associated with greater odds of any of the health indicators assessed. Among GB males, those with unsupportive parents were significantly more likely to report current binge drinking (AOR 6.94, 95% CI 1.70–28.35) and >15 days depression in the past month (AOR 6.08, 95% CI 1.15–32.15), and among LB females, those with unsupportive parents were significantly more likely to report lifetime illicit drug use (AOR 11.43, 95% CI 2.50–52.30), and >15 days depression in the past month (AOR 5.51, 95% CI 1.36–22.36). We conclude that coming out may be associated with better health for LB women, and that parents who react nonsupportively when their children disclose LGB sexual orientation may contribute to childrens increased odds of depression and hazardous substance use.

Determinants of body weight among men of different sexual orientation

OBJECTIVE To investigate eating habits and exercise behaviors as mediators in the relationship between sexual orientation and BMI in men. We hypothesized that sexual minority men (SMM) that is, men who identify as either homosexual or bisexual, have a lower BMI due to healthier eating habits and increased physical activity compared to heterosexual men. METHOD We used weighted data from the 2005 California Health Interview Survey to produce population-based estimates of the California male population. Numerous measures of eating and exercise habits, including daily servings of fruits and vegetables, and participation in varying levels of physical activity, were used in multiple regression models to test for mediation. RESULTS We found that SMM had significantly lower prevalence of overweight and obesity compared to straight men. Mediation was not confirmed, rather eating habits and exercise habits had an independent effect on BMI. CONCLUSIONS Because sexual orientation has an independent effect on BMI that is not mediated by eating or exercise behaviors, other factors explain the differences in BMI status between sexual minority and straight men.

Girl Child Marriage and Its Association With National Rates of HIV, Maternal Health, and Infant Mortality Across 97 Countries

This study was designed to assess associations between national rates of girl child marriage and national rates of HIV and maternal and child health (MCH) concerns, using national indicator data from 2009 United Nations reports. Current analyses were limited to the N = 97 nations (of 188 nations) for which girl child marriage data were available. Regression analyses adjusted for development and world region demonstrate that nations with higher rates of girl child marriage are significantly more likely to contend with higher rates of maternal and infant mortality and nonutilization of maternal health services, but not HIV.

The lack of cancer surveillance data on sexual minorities and strategies for change

ObjectiveTo consider options for gathering cancer incidence and risk factor data in sexual minority individuals.Methods and resultsSexual minority individuals may experience cancer risk disparities, due to lifestyle and reproductive differences compared with heterosexual people. However, cancer registry systems do not routinely collect sexual minority status. Other methods of obtaining such data and comparing cancer rates and risks between sexual minority and heterosexual people are discussed. These include building on existing registry membership with a targeted survey, using existing data sources, and estimating sexual orientation status with related data.ConclusionsEfforts described here could provide support for or refute the hypothesis that disparities exist in selected cancer rates in sexual minority populations and could guide targeted efforts to reduce any disparities.